The goal of the report, he said, is to "shine a light on the vulnerabilities that we have."

There is a "widespread mistaken belief" that infectious diseases are under control, commented Tom Inglesby, MD, head of the Center for Health Security at the University of Pittsburgh Medical Center.

The report, he said, will help "highlight ways we can continue to improve quality and investment in our systems."

A key finding is that investment in public health -- both on the state and federal level -- continues to fall. During 2012, 48% of all local health departments reduced spending in at least one program area, and some 44,000 public health jobs have been eliminated since 2008.

Public health systems can cope with day-to-day routine, he said, "but you need a certain amount of depth" to cope with emergencies.

And there is now "very, very little reserve in the system," Duchin said.

For the report, states got a single point for meeting each of 10 indicators:

Maintaining stable or increased public health budgets. Two-thirds of states cut financing for public health from 2011 to 2012.

Meeting the Department of Health and Human Services goal of immunizing 90% of children against whooping cough. Only two states and the District of Columbia met that goal.

Requiring the human papillomavirus vaccine for teens, paying for HPV vaccination efforts, or running education campaigns about the HPV vaccine. Fewer than half the states met any of those elements, and Levi told MedPage Today it's not clear that any state actually mandates the vaccination itself.

Vaccinating 50% of the population against the seasonal flu. Only a quarter of the states met the goal.

Having a plan to cope with infectious diseases, such as dengue, that will become more widespread owing to climate change. Fifteen states have such a plan.

Requiring reporting of healthcare-associated infections. In all, 35 states and the District of Columbia mandate such reporting.

Having enough laboratory capacity to track novel disease outbreaks.

Having the lab capacity to transport samples for testing. Most states said they could handle that -- 46 plus the District of Columbia.

Having the ability to respond to emergency events that require a 300% increase in activity. Public health labs in 36 states and the District of Columbia report they are prepared for a significant surge in testing over a 6- to 8-week period in response to an outbreak that increases testing over 300%.

Requiring Medicaid coverage of routine HIV screening. A total of 31 states and the District of Columbia mandate such coverage.

Not being in the yes column, the report noted, did not mean states were in the no column -- some simply did not respond.

The top of the heap was New Hampshire, the investigators found, with a yes answer on all but two -- the state did not get 90% of its children vaccinated against whooping cough or 50% of its citizens vaccinated against the flu.

On the bottom of the scale were Georgia, Nebraska, and New Jersey, with scores of just 20%.

The states were the focus of the report, but federal efforts also came in for criticism. The report noted that after adjusting for inflation, the CDC's budget fell from a high of $6.62 billion in 2005 to $6.32 billion in 2011.

And overall, between fiscal year 2010 and 2012, federal public health spending was reduced 8%, the report said.

The report, Duchin said, is "vitally important -- it's comprehensive, it covers all the key areas, and it's got some good recommendations."

For the infectious diseases society, he said, a central problem is the rise of antibiotic resistance, which the report "calls out" as a priority.

Among other things, the report urges a national effort to counter resistance and to develop new antibiotics. But aside from the issue of healthcare associated infections, Duchin noted, there is no indicator by which states and the federal government can be judged.

"We're not doing a good job of monitoring resistance," he said, which makes it hard to set up benchmarks. And in any case, resistance is "not a state problem, not a regional problem -- it's a global problem."

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